Health care mail bag

February 14, 2013 at 9:00 AM
- Last modified: February 14, 2013 at 9:40 AM

Heather Stauffer

Welcome to the Feb. 14 mail bag! No valentines, sorry – but plenty of health care news. Also, in honor of the day, I adopt the royal “we.”

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Dear U.S. Departments of Justice and Health & Human Services:

Thank you for informing us that, for the last three years, every $1 spent to fight health care fraud and abuse resulted in $7.90 being returned to the government. Those are sweet numbers, and it doesn’t surprise us that they represent the highest three-year average return on investment in the 16-year history of the program.

However, as investors, we’re a bit concerned by the simplicity of those numbers. We have reason to believe, for instance, that some of those enforcement actions necessitated additional provider paperwork, which always means money and doesn’t necessarily do anything at all to improve patient care. Those costs don’t show up on your balance sheet, but they do figure in the Overall Cost and Quality of U.S. Health Care, a concern in which we have invested heavily.

We’re not saying what you’re doing isn’t necessary, or even that you haven’t correctly calibrated the cost-benefit analysis for this stepped-up enforcement; we don’t have nearly enough details to make that call.

We’re just saying we doubt the true equation is as clear-cut as 1 to 7.9 and, well, we worry about systems becoming increasingly complex. We understand that it’s sometimes unavoidable, and sometimes even positive, but generally we’ve found increasing complexity to equal decreasing transparency and efficiency, which tend in turn to equal increasing cost and frustration. (See: Tax code.)